About 10-15% of women suffer from depression during pregnancy. The rates are probably even higher among those women who have histories of depression prior to pregnancy. Thus, many women with recurrent illness make the decision to remain on antidepressant during pregnancy. While there have been many studies supporting the reproductive safety of certain antidepressants, including Prozac and the tricyclic antidepressants, during pregnancy, concerns have emerged as to whether antidepressants, including the selective serotonin reuptake inhibitors (SSRIs), may increase the risk of adverse events in the newborn.

Depression during pregnancy is an important issue. To briefly summarize, several studies have demonstrated symptoms such as jitteriness, irritability, feeding difficulties, and poor neonatal adaptation in infants exposed to SSRIs in utero (Casper 2003, Laine et al. 2003, Simon et al. 2002, Zeskind and Stephens 2004). At this point, it is not known with certainty 1) how common these events are or 2) whether they are secondary to exposure to the medicine. In fact, women who are depressed and are taking no medications are more likely than non-depressed women to give birth to infants that are jittery and more difficult to soothe (Zuckerman et al, 1990). Furthermore, it is important to note that these reports suggest that the symptoms typically require no specific medical intervention and that they resolve spontaneously within 1-4 days, without any lasting effects.

These findings have prompted some physicians to urge their patients to discontinue treatment several weeks prior to delivery. At this point, it is not clear whether or not this type of intervention actually reduces the risk of adverse events in the neonate. What we suspect, however, is that withdrawing treatment as a woman enters into the postpartum period — a time of heightened vulnerability to depressive illness – places her at increased risk for depression and for the negative effects of this illness on her child. Thus, we do not typically recommend that antidepressants be discontinued prior to delivery.

Ruta Nonacs, MD, PhD

Zeskind P, Stephens L. 2004. Maternal Selective Serotonin Reuptake Inhibitor Use During Pregnancy and Newborn Neurobehavior. Pediatrics 113: 368-75.

Casper RC et al. 2003. Follow-up of children of depressed mothers exposed or not exposed to antidepressant drugs during pregnancy. J Pediatrics 142: 402-8.

Laine K, Heikkinen T, Ekblad U, Kero P. 2003. Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations. Arch Gen Psychiatry 60: 720-6.

Nulman I, Rovet J, Stewart DE, Wolpin J, Pace-Asciak P, Shuhaiber S, Koren G. 2002. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry 159: 1889-95.

Nulman I, Rovet J, Stewart D, Wolpin J, Gardner HA, et al. 1997. Neurodevelopment of children exposed in utero to antidepressant drugs. N Engl J Med 336: 258-62.

Simon GE, Cunningham ML, Davis RL. 2002. Outcomes of prenatal antidepressant exposure. Am J Psychiatry 159: 2055-61.

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